Keloid and hypertrophic scars: description, types, causes and treatment
After any injury on the skin, a person has a memorable scar mark, which in German means "scar".Sometimes these marks do not cause problems, either they are not in a prominent place, or almost indistinguishable from neighboring skin areas. But there are situations when the scars are too noticeable, convex, dark, sometimes with a highly corrugated surface. These are hypertrophic and keloid scars. Of course, they are a significant cosmetic defect, especially if located on the face, neck, chest. Getting rid of them is not so easy, because this kind of scars has a special fiber structure that is difficult to correct.
Types of scars
In some people, wounds are tightened quickly and almost painlessly. In others, this process stretches for weeks, and when, finally, the wounds heal, ugly rough marks remain in their place. Different "behavior" of tissues depends on many factors, for example, from infection of wounds, their location( mobile site or not), the size and depth of damage, the individual ability of the body to regenerate, the type of skin and so on. The combination of all these causes leads to the fact that in some cases, the scars are obtained as if sunk( they are called atrophic), while in others they are on the same level with skin integuments( normotrophic ones).
The most problematic, from the position of cosmetology, are hypertrophic scars. They appear, when in the healing tissues of the wound fibroblasts become too active and begin to intensify the synthesis of collagen. In this case, the enzyme collagenase, which destroys excess collagen, is produced in insufficient quantities. As a result of the new tissue, too much is formed. To go to surpluses there is no place, and they stick out above the healed place of damage. The height of such scars can reach 10 mm. Their color is generally darker than the skin in neighboring areas, and the surface often has a rough terrain.
These formations are very similar in appearance to hypertrophic scars, but they have a number of unpleasant differences. The main thing is that the keloid scars, appearing in the wound site, expand into undamaged skin areas. A trigger mechanism for them can be a large cut or a burn, as well as a minor injection, even an insect bite, to which many do not pay attention. The keloid scar begins to grow a month or more after the healing of the wound. Growth can last up to two years, after which the stabilization phase begins. In histological studies in keloids, too active giant fibroblasts, continuously producing collagen, are detected. And if the hypertrophic scars, though ugly, but painless, then keloid can cause itching, pain, increased sensitivity of the skin. Distinguish false keloids appearing at the site of trauma, and true, which occur where the skin is not outwardly damaged.
Treatment of keloid and hypertrophic scars
To date, the following methods for the correction of gross scars are used:
- silicone preparations( plates, gel);
- laser therapy;
- surgical intervention;
- cold treatment;
- drug therapy;
Any of them has its advantages and disadvantages. Which of the methods to apply, in each case, the doctor must decide. To remove hypertrophic, and furthermore keloid scars, which are often diagnosed as dermatofibroma and even infiltrating cancer, is necessary only in specialized clinics.
Hypertrophic and keloid scars are rarely removed surgically, because after such a correction there is almost always a relapse. For example, if we talk about keloids, the defect recovery takes place in 80-90% of all reported cases and manifests itself in the formation of scar tissue even larger than before removal. In the case of hypertrophic scars, the percentage of complications is somewhat lower. Surgical correction is best tolerated by narrow scars with sharp edges. During the operation, the surgeon cuts them, compares the edges of the incision, makes an internal seam, which is barely noticeable. This operation is performed under local anesthesia. Hospitalization is not required.
If extensive scars are removed by surgery, for example, burns, do patchwork of the skin( transplant).
Hypertrophic scarring in this way practically does not correct, but in the case of keloid it gives satisfactory results. The essence of the method is to apply a tight bandage to the place of the scar, which the patient wears, without removing, from 3 months to a year. Sometimes the dressing can be applied every 12 hours. Due to pressure on the vessels of the rumen, its nutrition ceases. Simultaneously, the edges of the scar tissue are squeezed, which prevents its further growth.
This method is considered to be the most effective and is used all over the world. Removal of hypertrophic scars, keloids and other formations on the skin is carried out by the so-called beech rays( X-ray radiation with the help of high-precision beta-applicators).As a result, fibroblasts are destroyed or stopped, the synthesis of collagen ceases. Beams of different intensity can be used.
In any case, 90% of them absorb the upper layers of the skin, and only 10% fall into the dermis. Often this method is used in conjunction with surgical removal of the scar. Relapses after such therapy are registered in 50% of cases. Due to the special effects of X-ray radiation, the method is not used to remove scars in the head, neck and chest area. Contraindications:
- heart and vascular disease;
- exacerbation of various diseases.
This is one of the safest and most effective methods. Keloids without relapses with cold help completely disappear in 51% of cases. And in 76% of cases, hypertrophic scars are removed. Treatment should be complex( cryotherapy and other methods - the use of ointments, silicone), then it makes sense to hope for almost complete( 90%) disappearance of scars, without complications and relapses. The essence of the method lies in the effect on the scar of liquid nitrogen( the temperature is about -196 ° C).It is applied with a tampon or with a special applicator. As a result, ice crystals form in the cells, the cytoplasm and organelles die. So fibroblasts are destroyed, collagen synthesis is stopped. Exposure to nitrogen lasts a maximum of 30 seconds, but most often 5 seconds is enough. To completely remove the scar, several procedures are sufficient. Disadvantages of the method:
- soreness procedure;
- possibility of blister formation at the site of the rumen;
- hyperpigmentation after the procedure.
Now the pharmaceutical companies have developed gels containing silicone, and special silicone plates. The principle of action of the drugs is approximately the same - they serve to maximize the hydration and softening of the body of scars, blocking the access of oxygen to its fibers and reducing the synthesis of collagen.
This method removes atrophic and hypertrophic scars. For the treatment of keloids, it does not fit. Plates are produced in different shapes and sizes. On the one hand, they have a sticky coating, ensuring the most dense adherence to the scar. Their structure is such that they pass air to the skin, while being waterproof. Advantages of the method are ease of use, relatively low price, painlessness and absence of complications, allergies, side effects. Disadvantages: duration of the procedure( several months) and low effect.
Many people ask how to remove the hypertrophic scar with a quick and noticeable effect. Injections of prolonged( with a long period of action) corticosteroids fulfill these desires of patients, and good results are achieved in the treatment of keloids. To date, the corticosteroids "Kenalog" and "DiPisan" are used. The mechanism of their action is approximately the same and consists in reducing the number of leukocytes and cytokines, suppressing the growth factor and necrosis of proliferation, inhibiting the work of fibroblasts, removing allergic reactions, reducing the level of collagen. The procedure is carried out once every 10-14 days. Side effects:
- protrusion of a reticulum of capillaries on the skin;
- appearance of steroid acne;
- thinning of the skin;
- has a general negative effect on the body.
To reduce side effects, corticosteroids are injected together with lidocaine( 1: 5), saline, pentoxifylline. An excellent result is given by this procedure in conjunction with cryotherapy.
Grinding hypertrophic scar or keloid with a laser gives the maximum effect. The essence of the procedure is a neat and very precise removal of the upper layer of the skin and scar tissue. As a result, the skin is renewed, a new elastin and collagen are formed in the treated area, the convexity of the scar is reduced, it is practically compared with the surrounding covers. After applying this method, hypertrophic scars disappear completely in 80-95%, and keloid scars in 60-70% of cases. Complications after the procedure:
- increased sensitivity of the skin to sunlight;
- of erythema;
- hyperpigmentation( passes without treatment);
- formation of cysts.
Laser exposure is ambulatory( deeper) and non-ampulative( more sparing).In the second case, complications are usually less, but the duration of treatment is longer.
There is an external treatment and by administering the medication to the body of the scar. For injections, preparations based on hyaluronidase( an enzyme, due to which hypertrophic scars become less edematous, soft, their relief flattened) are used. These include Lidaz, Alidaz, Longidaz, Vilidaz and others. Injections should be done every day or every 2 days for 1-2 weeks. Disadvantages of the method:
- enzyme instability;
- adverse reactions;
For external treatment use ointments, creams, sprays. In pharmacies, there is a wide selection of drugs that remove scars. The most popular are Kontraktubeks, Dermatics, Kelo-Kot, Kelobibraza. Advantages of the method are its ease, the ability to be treated at home, the absence of side effects. Disadvantages - in low efficiency.
Against keloid scars, ointments and injections are of little help, and treatment is only complex.
How to avoid the appearance of rough scars
If the wound is too large, the scar, one way or another, will remain. But in some cases, you can try to minimize its appearance. So, the hypertrophic scar after removal of the birthmark is almost never formed, if the procedure is performed by cryotherapy, electrocoagulation, using a laser. If the birthmark is removed surgically, the scar remains always. And if you remove it yourself, at home, the inflammatory process may begin, which will further exacerbate the situation.
In any injury to the skin, so that the wound heals better and faster, it is necessary to observe certain rules:
- do not allow dirt to get on the injured skin;
- avoid friction and touching the wound surface( eg clothing);
- in no case to rip off the crusts formed;
- protect the wound from direct sunlight;
- use special creams that help quick healing and reduce the risk of scars( one of the best among such drugs is "Kontraktubeks").